Prostate cancer: Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy - Initial experience Journal Article


Authors: Pucar, D.; Shukla-Dave, A.; Hricak, H.; Moskowitz, C. S.; Kuroiwa, K.; Olgac, S.; Ebora, L. E.; Scardino, P. T.; Koutcher, J. A.; Zakian, K. L.
Article Title: Prostate cancer: Correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy - Initial experience
Abstract: PURPOSE: To prospectively evaluate magnetic resonance (MR) imaging and MR spectroscopy for depiction of local prostate cancer recurrence after external-beam radiation therapy, with step-section pathologic findings as the standard of reference. MATERIALS AND METHODS: Study received institutional approval, and written informed consent was obtained. Study was compliant with Health Insurance Portability and Accountability Act. Sextant biopsy, digital rectal examination, MR imaging, MR spectroscopy, and salvage radical prostatectomy with step-section pathologic examination were performed in nine patients with increasing prostate-specific antigen levels after external-beam radiation therapy. MR imaging criterion for tumor was a focal nodular region of reduced signal intensity at T2-weighted imaging. MR spectroscopic criteria for tumor were voxels with choline (Cho) plus creatine (Cr) to citrate (Cit) ratio ([Cho + Cr]/Cit) of at least 0.5 or voxels with detectable Cho and no Cit in the peripheral zone. Sensitivity and specificity of sextant biopsy, digital rectal examination, MR imaging, and MR spectroscopy were determined by using a prostate sextant as the unit of analysis. For feature analysis, MR imaging and MR spectroscopic findings were correlated with step-section pathologic findings. RESULTS: MR imaging and MR spectroscopy showed estimated sensitivities of 68% and 77%, respectively, while sensitivities of biopsy and digital rectal examination were 48% and 16%, respectively. MR spectroscopy appears to be less specific (78%) than the other three tests, each of which had a specificity higher than 90%. MR spectroscopic feature analysis showed that a metabolically altered benign gland could be falsely identified as tumor by using MR spectroscopic criteria; further analysis of MR spectroscopic features did not lead to improved MR spectroscopic criteria for recurrent tumor. CONCLUSION: In summary, MR imaging and MR spectroscopy may be more sensitive than sextant biopsy and digital rectal examination for sextant localization of cancer recurrence after external-beam radiation therapy. © RSNA, 2005.
Keywords: adult; clinical article; middle aged; retrospective studies; cancer recurrence; cancer radiotherapy; nuclear magnetic resonance imaging; magnetic resonance imaging; prospective study; sensitivity and specificity; prostate specific antigen; tumor localization; tumor biopsy; prostate cancer; prostatic neoplasms; prostatectomy; magnetic resonance spectroscopy; choline; citric acid; creatine; nuclear magnetic resonance spectroscopy; digital rectal examination; beam therapy
Journal Title: Radiology
Volume: 236
Issue: 2
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2005-08-01
Start Page: 545
End Page: 553
Language: English
DOI: 10.1148/radiol.2362040739
PUBMED: 15972335
PROVIDER: scopus
PMCID: PMC2373272
DOI/URL:
Notes: --- - "Cited By (since 1996): 100" - "Export Date: 24 October 2012" - "CODEN: RADLA" - "Source: Scopus"
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MSK Authors
  1. Kentaro Kuroiwa
    28 Kuroiwa
  2. Peter T Scardino
    621 Scardino
  3. Semra Olgac
    98 Olgac
  4. Darko Pucar
    12 Pucar
  5. Chaya S. Moskowitz
    173 Moskowitz
  6. Hedvig Hricak
    333 Hricak
  7. Amita Dave
    80 Dave
  8. Kristen L Zakian
    74 Zakian
  9. Jason A Koutcher
    236 Koutcher
  10. Lanie Ebora
    2 Ebora